HomeMy WebLinkAboutX2019-2040 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit ApplicationNE �R>
Comm'I (—; Residential City of Newport Beach - Building Division (1-
Q NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Suite No
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Description of Work
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OWNER'S NAME
Last First .
Owner's Address
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Owner's E-mail Address
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City
State �I �j Zip Telephoned
AP 'LICANT'S NAME
Last �.G`S I First
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Applicant's Address
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Applicant's E-mail Address
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City /' L
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1 State �i /� —
Zip " / U �v Telephone �2
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ARCHITECT/DESIGNER'S NAME
Last
First
Lic. No. F�,
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State I Zip Telephone
ENGINEER'S NAME
Last First , Lic. No.�
Engineer's Address
Engineer's E-mail Address , 37-ol LV 3
City State Zip I Telephoner —
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
State
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
s Lic No. — �3 U�' Class
Contractor's E-mail Address
Zip �- Telephones
—
PERMIT NO./�_` U
PLAN CHECK NO. 1�t�
PLAN CHECK FEES $